Treatment of osteonecrosis with autologous bone marrow grafting
Treatment of osteonecrosis with autologous bone marrow grafting
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DOI：
10.1097/01.blo.0000038472.05771.79
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发表时间：
2002-12-01
影响因子：
4.2
通讯作者：
Beaujean, F
中科院分区：
文献类型：
--
作者：
Hernigou, P;Beaujean, F
植骨椎体减压是治疗股骨头坏死的常用方法。已经描述了许多不同的技术。在目前的系列中，移植是用从髋关节骨坏死患者的髂骨中获得的自体骨髓进行的。一项前瞻性研究的结果，189髋116例患者接受核心减压和自体骨髓移植治疗。患者随访5 ~ 10年。结果由Harris髋关节评分的变化、放射学分期的进展和髋关节置换术的需要决定。骨髓是在病人全身麻醉下采集的。常见部位为髂前嵴。用小套管针减压后，将抽取的骨髓通过浓度减少体积注入股骨头。当患者在塌陷前进行手术（I期和11期）时，145个髋关节中的9个进行了髋关节置换术。塌陷后手术的44个髋关节中有25个需要全髋关节置换术（III期和IV期）。为了测量移植的祖细胞数量，以成纤维细胞集落形成单位作为基质细胞活性的指标。髋部移植大量祖细胞的患者预后更好。
Core decompression with bone graft is used frequently in the treatment of osteonecrosis of the femoral head. Many different techniques have been described. In the current series, grafting was done with autologous bone marrow obtained from the iliac crest of patients operated on for osteonecrosis of the hip. The results of a prospective study of 189 hips in 116 patients treated with core decompression and autologous bone marrow grafting are reported. Patients were followed up from 5 to 10 years. The outcome was determined by the changes in the Harris hip score, by progression in radiographic stages, and by the need for hip replacement. The bone marrow was harvested with the patient under general anesthesia. The usual sites were the anterior iliac crests. The aspirated marrow was reduced in volume by concentration and injected into the femoral head after core decompression with a small trocar. When patients were operated on before collapse (Stage I and Stage 11), hip replacement was done in nine of the 145 hips. Total hip replacement was necessary in 25 hips among the 44 hips operated on after collapse (Stage III and Stage IV). To measure the number of progenitor cells transplanted, the fibroblast colony forming unit was used as an indicator of the stroma cell activity. Patients who had the greater number of progenitor cells transplanted in their hips had better outcomes.